Feb-Mar-97

Joyful Service In Healing

Dr. Patch Adams-doctor, clown, humorist, author, innovator, and social activist-believes that healing should be a loving, human interchange, not a business transaction. Founder and director of the Gesundheit Institute, a holistic medical community that has provided free medical care to thousands of patients since it began in 1971, Dr. Adams believes the problem in medicine is greed and malpractice; and the remedy is friendship, friendship, friendship, and friendship.

I got involved in social action in my teens through the civil rights movement and through losing my father as a result of war. I had a troubled teen life after my father's death, growing up overseas, then coming back to the South in 1961 to the civil rights movement. As an 18-year-old, I was hospitalized three times, twice for ulcers, once from a suicide attempt. I felt that man's inhumanity to man was bigger than I could take. My uncle had blown his brains out because of his own pressures and I had adopted him after my own father died. The world situation weighed on me and I was feeling powerless. That last hospitalization changed my life. I realized I wouldn't feel powerless if I was doing something about it, so I became a person who did something about it. As a political act, I decided to live a public life of joy and go into medicine and serve humanity.

I am an affirming person, so I entered medical school with the idea of creating a service that would address every single problem of care delivery in one model. When I graduated in 1971, other people were willing to try this experiment, so 20 of us moved into a large house that we called the hospital and where we lived with our families. We were packed to the gills, open 24 hours a day, 7 days a week. We saw everything from birth to death. In our first 12 years we had 500-1000 people in our home a month, 5-50 overnight guests. In that time we never charged money. In fact, what we want to do is eliminate the idea of debt in the medical interaction. We're really a political act to recreate the idea of community. We provide free services because we're part of a community and take care of the members of that community.

As a family doctor, I wanted to figure out what that meant as a role, so I started spending 3-4 hours in each initial visit with a patient. That way we realized how abysmally unhealthily most people lived. We decided to create a context where people could learn to live healthier, eat healthier, and exercise, but we also wanted to stimulate their love, their humor, their wonder, curiosity, passion, hope, and creativity, so we fully integrated medicine with performing.

It was breathtaking. Every day was ecstatic for me. It was such a rich medical environment, you could really explore people, explore their lives. They are very far from being a disease or some kind of number in a room. They're in your life with your families and you're able to talk about deeper things. I loved it. I've been a farmer, a goat-herder, built houses, produced a number of movies and plays and a whole lot of other things simply because we learned whatever people brought with them. We wanted to integrate agriculture because we were also concerned about the future of our agricultural planet.

We've also been the only hospital to fully integrate all the healing arts, the first wellness-centered hospital, the first art-centered hospital, the first silly hospital probably in history. Our staff worked irregular, part-time jobs to pay for this. We saw 15,000 people and never had any problems. We have never carried malpractice insurance; and we have never had anything to do with third party reimbursement, such as Medicare, Medicaid, Blue Cross. Initially we didn't carry malpractice insurance because we were a model to address all the problems of care delivery. Malpractice is a horrible problem to perpetrate on the medical profession, very expensive and pernicious. If you carry malpractice insurance you tell your patients, "I'm afraid of you and I don't trust you," so you live your entire professional career in mistrust. It sets up an adversarial relationship rather than a team approach. It's demeaning. It ties into the greed of patients who won't try to get better after something happened, so they'll look the worst possible they can in a lawsuit so they can get more money. One of the reasons we haven't been sued is because we love our patients. They come into our home. We give them our whole lives and don't charge them anything for that. I think the reports have shown that patients don't sue many family doctors. They mainly sue specialists.

The pharmaceutical companies have a huge hold on medical schools, on medical research, and on the consequences of what is researched and what isn't. There's a tremendous amount of power there. I have nothing good to say about pharmaceutical companies. That doesn't mean that I don't have something good to say about some pharmaceuticals, but they're way over-prescribed. I would not prescribe even a fraction of the numbers prescribed in our society. The point is not to get rid of all pharmaceuticals, but make them serve our society and not milk it dry out of greed.

The worst disease we have in this society, head and shoulders over AIDS and cancer, is loneliness. There's no disease that projects the pain and emptiness in a person's life like loneliness. Whether you look at psychology, anthropology, sociology, poetry, drama, fiction, the visual arts, the music of the last forty years- it's about alienation. It's about the lonely crowd. This aloneness is choking our society. I hear how desperately lonely people are from the moment I wake up until late evening when I go to bed.

Certainly there's breakdown of community, breakdown of families and interconnectedness-the impact of television on families, the personal computer. We've been working hard at alienation for some time before the modern technological revolution, pushing away people, not trusting people. We mainly get an education in not trusting strangers rather than an education in the stranger as a treasure just waiting to be opened up.

Now we're trying to build a 40-bed rural community hospital in West Virginia based on our principles. The total running and staffing and taking care of everything in the hospital will cost about 5% of the national average for a 40-bed hospital, eliminating 95% of the cost by moving it out of the greed sector and into the service sector. Last year over 2,000 doctors and nurses from around the world said if the hospital were open they would give us their lives to come and work full-time for free. That's certainly one way. We need another ethic. Right now the ethic we have in our society is money and power. We're trying to offer service and generosity and play and celebration as a much more meaningful ethic.

I think of ourselves as saying, okay, these are problems in health care delivery. Can we make care reasonably priced? Can we make a hospital where it's so attractive to work there doctors might be willing to work for free? Can we build a hospital that teaches being well? Can we build a hospital where all the healing arts work together equally and with great joy? Can we build a hospital that has no concerns for malpractice insurance and no hassle of insurance forms? Well, we did all that. We looked at the problems and then answered them.

It's not just looking at people and their health but at the health of their family, and the health of societies and communities that one can't really separate. The head of Humano, one of the largest medical chains, in 1992 was reported to have made $127 million a year. That's such a vulgar level of greed that it makes me weep. We've been the only model in America for 25 years addressing the problems of care delivery and we have not been able to interest foundations, government agencies, or corporations, even though we've come up with an answer-maybe not the answer, but an answer other than the garbage that's currently called the future of medicine-managed care.

The main way we will pay for ourselves is first eliminating 90-95% of the cost. In order to pay that 5%, our ideal is to have a mailing list of people who believe in what we're doing and who collectively send enough for our support. It has worked for 25 years. This project is involved all over the world and has been subsidized by generosity-our own generosity of the staff first and then the generosity of the people who like what we're doing. Schweitzer paid for his clinics by playing Bach in concert and fixing organs. We're not averse to that. People are also starting to name us in their wills and maybe we'll create an endowment. You don't need a very large endowment to bring in what our yearly cost would be.

The laws that appear to be working in our society are massive greed and massive power. There are other forces-wonderful small efforts all over the world trying to alter this idea-but when we have baseball stars and movie stars and rock musicians making millions of dollars, while our school teachers and social workers are making pennies, we know that our society has gone really haywire in its value systems.

We like to see ourselves as stimulants or irritants. We want people to dream big dreams and if they want something, put it right in their own house and start doing it.

Write to Dr. Patch Adams at 6877 Washington Blvd. Arlington, VA 22213.

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